| Doctor Name: | STACI ZONCA |
| NPI Number: | 1033579214 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA LLPC AODA |
| License Number: | 6401015286 |
| Business Practice Address: | 1255 N Oakland Blvd Waterford, MI - 483271545 |
| Business Phone Number: | 2485998999 |
| Business Fax Number: | |
| Mailing Address: | 1255 N Oakland Blvd, WATERFORD |
| State: | MI |
| Postal Code: | 483271545 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/01/2016 |
| NPI Last Update Date: | 03/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 6401015286 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |